Changes in cerebral hemodynamics assessed by transcranial Doppler ultrasonography in children after head injury

INTRODUCTION: Head injury is an important factor in children's morbidity and mortality. Arterial vasospasm and probably resulting from this, delayed ischemic deficit are important sequels of head trauma with detrimental effects on outcome. These problems have already been well studied in adults, but not in children. The noninvasiveness and ease in use of transcranial Doppler ultrasound technique (TCD) make it an ideal tool for the assessment of changes in cerebral circulation not only for the purposes of diagnosis but also for follow-up. PATIENTS AND METHODS: The authors review the present literature and analyze the usefulness of TCD as used in a group of 27 head-injured children aged 3-16 years. GCS/CCS score, CT pictures and neurological status were estimated. TCD examination was performed on the 2nd day after injury and each of the following 5 days or until normalization of flow velocities. Blood flow velocity was measured in the middle cerebral artery, the anterior cerebral artery and the extracranial portion of the internal carotid artery. The pulsatility index was also read.RESULTS: A significant correlation was found between changes in blood flow parameters and neurological status. High blood flow velocities seemed to be caused by hyperemia rather than by vasospasm. CONCLUSION: The results confirm that TCD is a useful method in the management of children after head injury.